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General NPI Number Information
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NPI Number | 1376820506
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Entity Type | Organization
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Legal Business Name | VICTOR I LYDAY MD PA
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 1303 MCCULLOUGH AVE SUITE 361
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City | SAN ANTONIO
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State | TX
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Zip | 78212-5609
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Country | US
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Telephone | 210-224-2639
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Fax |
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Provider Business Mailing Address
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Address Line | 1303 MCCULLOUGH AVE SUITE 361
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City | SAN ANTONIO
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State | TX
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Zip | 78212-5609
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTOR I LYDAY
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Credential | MD
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Telephone | 210-224-2639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | D9954
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License Number State | TX
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